April 20, 2020

So, I’ve Been Thinking: What COVID-19 Reveals About Our Public Health System

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CEG Founder & Executive Director, A. Toni Young, with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases

So, I’ve been thinking about how none of us can truly avoid the impact of COVID-19. Either we know someone who’s been impacted by it, or we have been impacted by it ourselves, or maybe we are now working from home, even reconfiguring our whole organizations and the way we do our work. Everybody is impacted—but I’ve been thinking especially about how COVID-19 impacts the most vulnerable, and what this shows about the gaps in our health system.

It is no surprise that already-vulnerable groups need protection during this pandemic. CEG’s mission is built around addressing social, economic and environmental factors that generate health disparities in low-income communities, among people of color, and in marginalized groups such as the LGBTQIA+ community. That mission is also what ultimately led CEG to expand its operations beyond urban communities of color.

It turns out that poor rural communities in states like Louisiana, West Virginia, Missouri, and Mississippi actually have a lot in common with poor urban communities, in terms of vulnerability due to underlying social determinants of health. Yet some poor and rural states have been slower to respond to the pandemic, perhaps in part because lower population density in rural areas may seem to mitigate risk. Unfortunately this can lull people into a false sense of security, causing them to neglect taking precautions like physical distancing, wearing a mask, and washing hands.

Rural areas also tend to have fewer doctors and nurses. Here in West Virginia, almost 20% of adults do not have a personal doctor or primary care provider. This shortfall could result in underreporting, as well as making it harder for people to get referrals for testing. Even when people do have doctors, transportation issues can limit their access to healthcare services. Add to that factors like poverty, food insecurity, low rates of literacy and education, and frequent distrust of government, and you begin to understand how vulnerable these communities can be. The COVID Community Vulnerability Map created by the healthcare analytics company Jvion illustrates this clearly.

These parallels between vulnerable urban and rural communities make it clear that even while many of us advocate for different demographics and constituencies, we can and must come together in our response to COVID-19, just as we must unite in responding to ongoing threats such as HIV, hepatitis, and opioid use. We can no longer afford to operate in isolation, or respond in isolation when a crisis hits. We all need to work together to ensure that our citizens are protected and cared for.

At CEG, we hope to start up a “getting to know you” webinar series about these common struggles shared by disparate communities whether they urban or rural, black or white. But that’s just the beginning. If we are going to become more resilient, we have to absorb the lessons COVID-19 is teaching us about our health system. As recently noted by Hanna Love and Jennifer S. Vey of the Brookings Institution, in moving forward we should “adopt service-based systems or outreach-team approaches that connect people with permanent supportive housing, employment training, child care subsidies, doctors and therapists, and financial and budgeting assistance.”

To accomplish this, we will need to fashion a network of responders for our communities that is diverse. We will need to look at what we have and what we can bring to the collective. If we come together and we work together on goals like improving mobility and portability of services, we can reach the people who are in the greatest need. Some of these people are poor, black or brown, living with HIV. Others are white, rural, drug users. All of them need us to work collectively, reimagine how we address health crises, and build a stronger and fairer system that can help prevent such crises in the future. That’s how we get better and stay better: together.

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